Provider Demographics
NPI:1841373016
Name:BJORKMAN, ERIC J (PT, CO)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:J
Last Name:BJORKMAN
Suffix:
Gender:M
Credentials:PT, CO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2130 S 17TH ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68502-3750
Mailing Address - Country:US
Mailing Address - Phone:402-476-6575
Mailing Address - Fax:402-476-6576
Practice Address - Street 1:2130 S 17TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68502-3750
Practice Address - Country:US
Practice Address - Phone:402-476-6575
Practice Address - Fax:402-476-6576
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2013-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1985225100000X
222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025409200Medicaid
099781Medicare ID - Type UnspecifiedGROUP MEDICARE #
279628Medicare ID - Type UnspecifiedINDIVIDUAL MEDICARE #